Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC TRANSGLUTAMINASE IGA AB

Facility

$230.00

Service Code	CPT 83516
Hospital Charge Code	900913555
Hospital Revenue Code	302
Min. Negotiated Rate	$126.50
Max. Negotiated Rate	$184.00
Rate for Payer: Cash Price	$103.50
Rate for Payer: Cigna of CA HMO/PPO	$184.00
Rate for Payer: Health Smart Auto/Commercial	$138.00
Rate for Payer: LLUH Dept of Risk Management WC	$126.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$172.50

HC TRANSTHYRETIN

Facility

$45.00

Service Code	CPT 84134
Hospital Charge Code	900910925
Hospital Revenue Code	301
Min. Negotiated Rate	$24.75
Max. Negotiated Rate	$33.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$27.00
Rate for Payer: Aetna of CA Government/Medicare	$27.00
Rate for Payer: Cash Price	$20.25
Rate for Payer: Health Smart Auto/Commercial	$27.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$27.00
Rate for Payer: LLUH Dept of Risk Management WC	$24.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$33.75

HC TRANSTHYRETIN

Facility

$332.00

Service Code	CPT 84134
Hospital Charge Code	900910925
Hospital Revenue Code	301
Min. Negotiated Rate	$182.60
Max. Negotiated Rate	$265.60
Rate for Payer: Cash Price	$149.40
Rate for Payer: Cigna of CA HMO/PPO	$265.60
Rate for Payer: Health Smart Auto/Commercial	$199.20
Rate for Payer: LLUH Dept of Risk Management WC	$182.60
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$249.00

HC TRICHROME TEST

Facility

$84.00

Service Code	CPT 88313
Hospital Charge Code	900911728
Hospital Revenue Code	306
Min. Negotiated Rate	$46.20
Max. Negotiated Rate	$63.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$50.40
Rate for Payer: Aetna of CA Government/Medicare	$50.40
Rate for Payer: Cash Price	$37.80
Rate for Payer: Health Smart Auto/Commercial	$50.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$50.40
Rate for Payer: LLUH Dept of Risk Management WC	$46.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$63.00

HC TRICHROME TEST

Facility

$480.00

Service Code	CPT 88313
Hospital Charge Code	900911728
Hospital Revenue Code	306
Min. Negotiated Rate	$264.00
Max. Negotiated Rate	$384.00
Rate for Payer: Cash Price	$216.00
Rate for Payer: Cigna of CA HMO/PPO	$384.00
Rate for Payer: Health Smart Auto/Commercial	$288.00
Rate for Payer: LLUH Dept of Risk Management WC	$264.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$360.00

HC TRICHROME TEST

Facility

$480.00

Service Code	CPT 88313 90
Hospital Charge Code	900911728
Hospital Revenue Code	306
Min. Negotiated Rate	$264.00
Max. Negotiated Rate	$384.00
Rate for Payer: Cash Price	$216.00
Rate for Payer: Cigna of CA HMO/PPO	$384.00
Rate for Payer: Health Smart Auto/Commercial	$288.00
Rate for Payer: LLUH Dept of Risk Management WC	$264.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$360.00

HC TRIGLYCERIDES

Facility

$19.00

Service Code	CPT 84478
Hospital Charge Code	900910234
Hospital Revenue Code	301
Min. Negotiated Rate	$10.45
Max. Negotiated Rate	$14.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$11.40
Rate for Payer: Aetna of CA Government/Medicare	$11.40
Rate for Payer: Cash Price	$8.55
Rate for Payer: Health Smart Auto/Commercial	$11.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$11.40
Rate for Payer: LLUH Dept of Risk Management WC	$10.45
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$14.25

HC TRIGLYCERIDES

Facility

$89.00

Service Code	CPT 84478
Hospital Charge Code	900910234
Hospital Revenue Code	301
Min. Negotiated Rate	$48.95
Max. Negotiated Rate	$71.20
Rate for Payer: Cash Price	$40.05
Rate for Payer: Cigna of CA HMO/PPO	$71.20
Rate for Payer: Health Smart Auto/Commercial	$53.40
Rate for Payer: LLUH Dept of Risk Management WC	$48.95
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$66.75

HC TRIGLYCERIDES BODY FLUID

Facility

$25.00

Service Code	CPT 84478
Hospital Charge Code	900912247
Hospital Revenue Code	301
Min. Negotiated Rate	$13.75
Max. Negotiated Rate	$20.00
Rate for Payer: Cash Price	$11.25
Rate for Payer: Cigna of CA HMO/PPO	$20.00
Rate for Payer: Health Smart Auto/Commercial	$15.00
Rate for Payer: LLUH Dept of Risk Management WC	$13.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$18.75

HC TRIGLYCERIDES BODY FLUID

Facility

$17.00

Service Code	CPT 84478
Hospital Charge Code	900912247
Hospital Revenue Code	301
Min. Negotiated Rate	$9.35
Max. Negotiated Rate	$12.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$10.20
Rate for Payer: Aetna of CA Government/Medicare	$10.20
Rate for Payer: Cash Price	$7.65
Rate for Payer: Health Smart Auto/Commercial	$10.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$10.20
Rate for Payer: LLUH Dept of Risk Management WC	$9.35
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$12.75

HC TRIGLYCERIDES INDIVIDUAL

Facility

$89.00

Service Code	CPT 84478
Hospital Charge Code	900910526
Hospital Revenue Code	301
Min. Negotiated Rate	$48.95
Max. Negotiated Rate	$71.20
Rate for Payer: Cash Price	$40.05
Rate for Payer: Cigna of CA HMO/PPO	$71.20
Rate for Payer: Health Smart Auto/Commercial	$53.40
Rate for Payer: LLUH Dept of Risk Management WC	$48.95
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$66.75

HC TRIGLYCERIDES INDIVIDUAL

Facility

$19.00

Service Code	CPT 84478
Hospital Charge Code	900910526
Hospital Revenue Code	301
Min. Negotiated Rate	$10.45
Max. Negotiated Rate	$14.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$11.40
Rate for Payer: Aetna of CA Government/Medicare	$11.40
Rate for Payer: Cash Price	$8.55
Rate for Payer: Health Smart Auto/Commercial	$11.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$11.40
Rate for Payer: LLUH Dept of Risk Management WC	$10.45
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$14.25

HC TRIIODOTHYRONINE, FREE

Facility

$65.00

Service Code	CPT 84481
Hospital Charge Code	900912135
Hospital Revenue Code	301
Min. Negotiated Rate	$35.75
Max. Negotiated Rate	$48.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$39.00
Rate for Payer: Aetna of CA Government/Medicare	$39.00
Rate for Payer: Cash Price	$29.25
Rate for Payer: Health Smart Auto/Commercial	$39.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$39.00
Rate for Payer: LLUH Dept of Risk Management WC	$35.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$48.75

HC TRIIODOTHYRONINE, FREE

Facility

$276.00

Service Code	CPT 84481
Hospital Charge Code	900912135
Hospital Revenue Code	301
Min. Negotiated Rate	$151.80
Max. Negotiated Rate	$220.80
Rate for Payer: Cash Price	$124.20
Rate for Payer: Cigna of CA HMO/PPO	$220.80
Rate for Payer: Health Smart Auto/Commercial	$165.60
Rate for Payer: LLUH Dept of Risk Management WC	$151.80
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$207.00

HC TRMNT ANGER-PROBLEM SOLVING

Facility

$325.00

Service Code	CPT 90853
Hospital Charge Code	907804064
Hospital Revenue Code	905
Min. Negotiated Rate	$41.00
Max. Negotiated Rate	$520.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$475.00
Rate for Payer: Beacon Health Medi-Cal/Medicare Advantage	$400.00
Rate for Payer: Blue Shield of California Commercial	$349.00
Rate for Payer: Cash Price	$146.25
Rate for Payer: Cash Price	$146.25
Rate for Payer: Cash Price	$146.25
Rate for Payer: Cigna of CA HMO/PPO	$316.00
Rate for Payer: Health Smart Auto/Commercial	$426.00
Rate for Payer: Heritage Provider Network Commercial	$281.00
Rate for Payer: Heritage Provider Network Senior	$281.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal/Medicare Advantage	$330.00
Rate for Payer: Intervalley Health Plan Commercial	$520.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$293.00
Rate for Payer: LLUH Dept of Risk Management WC	$178.75
Rate for Payer: Magellan Commercial	$406.00
Rate for Payer: Managed Health Network (MHN) Commercial	$434.00
Rate for Payer: Managed Health Network (MHN) Medicare	$111.37
Rate for Payer: Mary Free Bed Workers' Compensation	$41.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$243.75
Rate for Payer: US Behavioral Health Commercial/Medicare	$397.33

HC TRMNT ANGER-PROBLEM SOLVING

Facility

$325.00

Service Code	CPT 90853
Hospital Charge Code	907804064
Hospital Revenue Code	942
Min. Negotiated Rate	$41.00
Max. Negotiated Rate	$243.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$55.76
Rate for Payer: Aetna of CA Government/Medicare	$55.76
Rate for Payer: Cash Price	$146.25
Rate for Payer: Cash Price	$146.25
Rate for Payer: Health Smart Auto/Commercial	$195.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$195.00
Rate for Payer: LLUH Dept of Risk Management WC	$178.75
Rate for Payer: Mary Free Bed Workers' Compensation	$41.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$243.75

HC TRMNT ANGER-PROBLEM SOLVING

Facility

$325.00

Service Code	CPT G0177
Hospital Charge Code	907804064
Hospital Revenue Code	942
Min. Negotiated Rate	$178.75
Max. Negotiated Rate	$243.75
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$195.00
Rate for Payer: Aetna of CA Government/Medicare	$195.00
Rate for Payer: Cash Price	$146.25
Rate for Payer: Health Smart Auto/Commercial	$195.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$195.00
Rate for Payer: LLUH Dept of Risk Management WC	$178.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$243.75

HC TRMNT ANGER-PROBLEM SOLVING

Facility

$325.00

Service Code	CPT 90853
Hospital Charge Code	907804064
Hospital Revenue Code	905
Min. Negotiated Rate	$178.75
Max. Negotiated Rate	$469.00
Rate for Payer: Cash Price	$146.25
Rate for Payer: Cash Price	$146.25
Rate for Payer: Cigna of CA HMO/PPO	$260.00
Rate for Payer: Health Smart Auto/Commercial	$195.00
Rate for Payer: LLUH Dept of Risk Management WC	$178.75
Rate for Payer: Mary Free Bed Workers' Compensation	$469.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$243.75

HC TRMNT ANGER-PROBLEM SOLVING

Facility

$325.00

Service Code	CPT 90853
Hospital Charge Code	907804064
Hospital Revenue Code	942
Min. Negotiated Rate	$178.75
Max. Negotiated Rate	$260.00
Rate for Payer: Cash Price	$146.25
Rate for Payer: Cigna of CA HMO/PPO	$260.00
Rate for Payer: Health Smart Auto/Commercial	$195.00
Rate for Payer: LLUH Dept of Risk Management WC	$178.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$243.75

HC TRMNT ANGER-PROBLEM SOLVING

Facility

$325.00

Service Code	CPT G0177
Hospital Charge Code	907804064
Hospital Revenue Code	942
Min. Negotiated Rate	$178.75
Max. Negotiated Rate	$260.00
Rate for Payer: Cash Price	$146.25
Rate for Payer: Cigna of CA HMO/PPO	$260.00
Rate for Payer: Health Smart Auto/Commercial	$195.00
Rate for Payer: LLUH Dept of Risk Management WC	$178.75
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$243.75

HC TRMNT ED HEALTH EDUCATION

Facility

$335.00

Service Code	CPT G0177
Hospital Charge Code	907804147
Hospital Revenue Code	942
Min. Negotiated Rate	$184.25
Max. Negotiated Rate	$268.00
Rate for Payer: Health Smart Auto/Commercial	$201.00
Rate for Payer: Cash Price	$150.75
Rate for Payer: Cigna of CA HMO/PPO	$268.00
Rate for Payer: LLUH Dept of Risk Management WC	$184.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$251.25

HC TRMNT ED HEALTH EDUCATION

Facility

$335.00

Service Code	CPT 90853
Hospital Charge Code	907804147
Hospital Revenue Code	942
Min. Negotiated Rate	$184.25
Max. Negotiated Rate	$268.00
Rate for Payer: Cash Price	$150.75
Rate for Payer: Cigna of CA HMO/PPO	$268.00
Rate for Payer: Health Smart Auto/Commercial	$201.00
Rate for Payer: LLUH Dept of Risk Management WC	$184.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$251.25

HC TRMNT ED HEALTH EDUCATION

Facility

$335.00

Service Code	CPT 90853
Hospital Charge Code	907804147
Hospital Revenue Code	942
Min. Negotiated Rate	$41.00
Max. Negotiated Rate	$251.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$55.76
Rate for Payer: Aetna of CA Government/Medicare	$55.76
Rate for Payer: Cash Price	$150.75
Rate for Payer: Cash Price	$150.75
Rate for Payer: Health Smart Auto/Commercial	$201.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$201.00
Rate for Payer: LLUH Dept of Risk Management WC	$184.25
Rate for Payer: Mary Free Bed Workers' Compensation	$41.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$251.25

HC TRMNT ED HEALTH EDUCATION

Facility

$335.00

Service Code	CPT G0177
Hospital Charge Code	907804147
Hospital Revenue Code	942
Min. Negotiated Rate	$184.25
Max. Negotiated Rate	$251.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$201.00
Rate for Payer: Aetna of CA Government/Medicare	$201.00
Rate for Payer: Cash Price	$150.75
Rate for Payer: Health Smart Auto/Commercial	$201.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$201.00
Rate for Payer: LLUH Dept of Risk Management WC	$184.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$251.25

HC TRMNT ED HEALTH EDUCATION

Facility

$335.00

Service Code	CPT 90853
Hospital Charge Code	907804147
Hospital Revenue Code	905
Min. Negotiated Rate	$184.25
Max. Negotiated Rate	$469.00
Rate for Payer: Cash Price	$150.75
Rate for Payer: Cash Price	$150.75
Rate for Payer: Cigna of CA HMO/PPO	$268.00
Rate for Payer: Health Smart Auto/Commercial	$201.00
Rate for Payer: LLUH Dept of Risk Management WC	$184.25
Rate for Payer: Mary Free Bed Workers' Compensation	$469.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$251.25

Know your out-of-pocket cost for care.

All Charges